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Images in Neurology |

Spinal Subdural Abscess

John J. McCabe, MB, BCh, BAO; Raymond P. Murphy, FRCPI
JAMA Neurol. 2013;70(2):266-267. doi:10.1001/jamaneurol.2013.588.
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A 59-year-old woman had a 1-month history of polyarthralgia and swelling in the joints of her hands and feet. She then developed lower back pain and confusion. On examination, she was pyrexic and tachycardic. Edema and tenderness of the wrists and interphalangeal joints were noted.

Investigations showed an increased C-reactive protein level of 265 mg/L (to convert to nanomoles per liter, multiply by 9.524). Blood culture results were positive for Staphylococcus aureus. A chest x-ray, urine culture results, transthoracic echocardiogram, and abdominal ultrasonography scan were normal. Treatment with broad-spectrum intravenous antibiotics was commenced.

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Figure 1. Brain magnetic resonance image (T1 weighted with gadolinium). Bilateral gadolinium-enhancing collections are seen in the posterior fossa consistent with subdural abscess (arrows).

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Figure 2. Thoracic spine magnetic resonance images. A, Image is T1 weighted with gadolinium. An enhancing lesion posterior to the spinal cord in keeping with subdural empyema is shown. It extends from the level of the cervical cord to the thoracic cord (arrows). B, T2-weighted image. A high-signal abnormality involving the anterior thoracic cord and conus is seen consistent with an anterior spinal artery occlusion (arrows).

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